Pediatric Spinal Neuroschistosomiasis in Yemen: An Overlooked Dilemma in an Endemic Region

Abstract

Background: Neurological involvement in schistosomiasis presents a significant and serious complication. While the disease is generally considered treatable during the early stages, the rarity of this condition often leads to delays in diagnosis and treatment. This study aims to report the clinical characteristics of pediatric patients with spinal neuroschistosomiasis (NS) in an endemic area to the disease.Methods: A retrospective cross-sectional review was conducted at Althora General Hospital in Ibb, Yemen, from January 2016 to January 2021. The study examined confirmed pediatric cases of spinal NS, analyzing their clinical characteristics, laboratory and radiological data, treatment approaches, and complications.Results: The study identified 10 cases of spinal NS with a mean age of 10.1± 3.2 years. The majority (90%) were male and from rural areas, all with a history of freshwater exposure, a known risk factor for schistosomiasis. The average time from presentation to treatment was 33.4± 45.6 days (7-150 days). Common symptoms observed in all patients were bladder dysfunction and paresthesia (100%). Intestinal dysfunction was prevalent in 90% of cases, while 80% exhibited limb weakness or inability to walk. The diagnosis was confirmed through cerebrospinal fluid (CSF) serology in 80% of cases, and stool and urine exams yielded positive results in 90% and 30% of cases, respectively. Magnetic Resonance Imaging findings revealed medullary lesions in 50% of cases, cauda equina lesions in 20%, and multiple lesions in 30%. All patients received oral praziquantel and high-dose steroids for at least three days as part of their initial treatment. During the average follow-up period of 5.6±1.7 months, one patient experienced lower extremity paraplegia, while two cases (20%) showed partial improvement with residual deficits including urinary and fecal incontinence. Complete resolution of symptoms was achieved in seven cases (70%).Conclusion: Schistosomiasis should be considered in pediatric patients with myeloradicular manifestations, especially in endemic areas. Early identification can be achieved through history, prompt imaging, and CSF serology. In the absence of immediate test results, expert-guided presumptive therapy should be considered to minimize neurological complications.

Conus medullaris neuroschistosomiasis mimicking Guillain–Barre syndrome: A case of delayed diagnosis leading to permanent neurological damage

“…3 Achieving positive treatment outcomes is heavily reliant on early detection and timely treatment with the administration of high-dose steroids and praziquantel. 4 Despite the relatively favorable prognosis, delayed recognition and intervention can be associated with permanent neurological deficits. 2 While post-mortem studies have indicated a three to four times higher prevalence rate of asymptomatic NS cases, 5 the variability of clinical presentation and low index of suspicion can lead to misdiagnosis, even among symptomatic cases.…”

“…Nonetheless, the presentation of NS can be nonspecific, mimicking transverse myelitis or intra‐axial spinal tumors, particularly with conus intramedullary extension 3 . Achieving positive treatment outcomes is heavily reliant on early detection and timely treatment with the administration of high‐dose steroids and praziquantel 4 . Despite the relatively favorable prognosis, delayed recognition and intervention can be associated with permanent neurological deficits 2 .…”